title: Determining health insurance coverage of technology: problems and options.
abstract: By deciding which medical procedures are eligible for reimbursement, health insurance programs possess the potential to affect significantly technology use and health care spending. Traditionally, insurers have adopted a passive stance and made relatively few negative coverage determinations. However, resistance to rapidly rising costs has created a powerful inducement for third-party payors to become more prudent purchasers of health care services. Consequently, both Medicare and Blue Cross--Blue Shield are considering the implementation of changes that may ultimately result in more restrictive coverage decisions. This article examines the coverage process of Medicare and Blue Cross--Blue Shield and the policy changes that both programs are considering. In addition, it discusses the strengths and drawbacks of four coverage policy options: restricting insurance coverage of unproven procedures, introducing cost-effectiveness criteria, educating physicians and educating consumers.
mesh_terms: D054598:Blue Cross Blue Shield Insurance Plans / Q000191:economics; D003256:Community Participation; D003362:Cost-Benefit Analysis; D004059:Diffusion of Innovation; D006291:Health Policy; D007342:Insurance Benefits; D007349:Insurance, Health, Reimbursement / Q000331:legislation & jurisprudence*; D013677:Medical Laboratory Science / Q000191:economics*; D006278:Medicare / Q000331:legislation & jurisprudence; D010819:Physician's Role; D014481:United States